Early steroid withdrawal in pediatric renal transplant on newer immunosuppressive drugs

Abstract

Steroids have been a cornerstone in renal transplant immunosuppression. New immunosuppressive drugs have led to protocols using early steroid withdrawal or complete avoidance. A prospective protocol in 23 pediatric renal transplant (ages 2-14 yr) who received decreasing steroid doses stopping at day 7 post-Tx, FK, and MMF were compared with a CsA, AZT, historically matched steroid-based control group. Basiliximab was used in two doses. Anthropometric, biochemical variables, AR rates, and CMV infection were evaluated and compared using Student's t-test and regression analysis. A better growth pattern was seen in steroid withdrawal group. GFR rate and serum glucose were similar in both groups. Total serum cholesterol levels were significantly lower in steroid withdrawal group. The incidence of AR at 12 months was 4.3% in steroid withdrawal group vs. 8.6% in steroid-based group (p = ns). No difference in CMV infection was observed. Hemoglobin levels were low during the first months in both groups; reached normal values after six months. SBP became higher at 12 months in steroid-based group. Patient and graft survival was 98% in both groups at one-yr post-transplant. Early steroid withdrawal was efficacious, safe, and did not increase risk of rejection, preserving optimal growth, renal function, and reducing cardiovascular risk factors.

Outcomes of Steroid-Avoidance Protocols in Pediatric Kidney Transplant Recipients

“…The percentage of children receiving steroid-avoidance protocols was between 26% and 28% among all HLA match categories, suggesting that recipients of poorly matched allografts are equally eligible for steroid-avoidance protocols. In contrast, several studies have included elevated PRA values among the exclusion criteria for steroid avoidance (3,6,11) which is consistent with the association of lower PRA values with steroid avoidance observed in our cohort.…”

Early steroid withdrawal in pediatric renal transplant: five years of follow-up

“…Intermediate-term follow-up (5-7 years) is now available for some trials with encouraging results in adults [14,15] but published experience in the pediatric population is still scarce [16,17]. Our first experience with early withdrawal of steroids was reported in a preliminary study that included 23 pediatric renal transplant recipients [18].…”

Steroid Minimization in Pediatric Renal Transplantation

“…Since the first anecdotal success by Birkeland et al with the use of a steroid free regimen in 14 pediatric patients, many centers, including ours, have reported their successful experience with steroid minimization in pediatric allograft recipients, using various novel protocols in a non-randomized manner [17][18][19][20][21][22][23][24]. These reports not only further support the feasibility and safety of steroid avoidance or minimization but they also affirm the potential metabolic benefits observed in adult patients.…”